Transforming the way we eat

Dr Jessica Fanzo stood in front of a large screen filled with a colourful plate of food.

Most of it was filled with an assortment of fruits, vegetables, plant-based proteins, legumes and nuts.

A sliver of the plate was reserved for animal-sourced protein and dairy products, some added sugars and starchy vegetables.

“This is the reference diet, and much of it is mired in controversy and debate,” explained Fanzo, director of the global food ethics and policy programme at Johns Hopkins University, to the thousand-odd delegates attending the EAT Stockholm Food Forum 2019 in Sweden last week.

“Obviously, as many other reports have shown, we need to increase wholegrains, fruits, vegetables, legumes, healthy nuts, seeds and reduce the amount of protein sources, particularly red meat and processed meat.”

Fanzo is one of 37 authors of Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems, a three-year undertaking published in January in The Lancet.

Their planetary health diet is the first attempt to set universal scientific targets for the food system, “good for both people and the planet”. It requires huge cuts in the consumption of red meat in Western countries, a shift towards mostly plant based dietary patterns, and dramatic reductions in food losses and waste.

The team of scientists, drawn from human health, agriculture, political sciences and environmental sustainability, argue how the global food system is unsustainable, with food production being the largest culprit of global environmental change, threatening climate stability and ecosystem resilience.

Agriculture occupies nearly 40% of global land, making agro ecosystems the largest terrestrial ecosystems on the planet. Food production is responsible for up to 30% of global greenhouse gas emissions and 70% of freshwater use. Land conversion for food production is the single most important driver of biodiversity loss.

Feeding 10billion people by 2050 will require substantial dietary shifts. “This includes a more than doubling in the consumption of healthy foods such as fruits, vegetables, legumes and nuts and a greater than 50% reduction in global consumption of less healthy foods such as added sugars and red meat, primarily by reducing excessive consumption in Western countries.”

Some populations worldwide depend on animal protein from livestock, while many continue to face significant burdens of under-nutrition. “Obtaining adequate quantities of micro nutrients from plant source foods can be difficult. The role of animal source foods in people’s diets must be carefully considered in each context and within local and regional realities.”

Feeding 10 billion people a healthy diet within safe planetary boundaries for food production by 2050 is “both possible and necessary” and the universal adoption of a planetary health diet would help avoid severe environmental degradation and prevent around 11 million deaths a year.

“How food is produced, what is consumed and how much is wasted all heavily shape the health of both people and planet,” say the authors. “The commission presents an integrated global framework and for the first time provides quantitative scientific targets for healthy diets and sustainable food production.”

Their “win win” flexitarian diet, which the commission maintains is nutritionally sound, can optionally include modest amounts of fish, meat and dairy foods and “allows for adaptation to dietary needs, personal preferences and cultural traditions”.

A diet that includes more plant-based foods and fewer animal source foods will cut the incidences of heart disease, diabetes and cancer. “It is not a question of all or nothing, but rather small changes for a large and positive impact,” says the EAT-Lancet commission.

Globally, over 820 million people continue to go hungry every day, 150 million children suffer from long-term hunger that impairs their growth and development, and 50million children are acutely hungry due to insufficient access to food.

Over 2 billion adults are overweight and obese and diet-related non-communicable diseases including diabetes, cancer and heart diseases are among the chief causes of global deaths.

Unhealthy diets now pose a greater risk to morbidity and mortality than unsafe sex, alcohol, drug and tobacco use combined, say the authors.

In addition, around one third of the food produced in the world for human consumption every year, around 1.3 billion tons, is lost or wasted.

“We’re clearly in a situation where food and environment are considered massive global risks to society,” remarks Fanzo.

Belinda Reyers, a professor of sustainability science at Stellenbosch University, says South Africa would likely align with the global finding that the way it produces and consumes food will be one of the main determinants of its future, the future health of its people and the environment.

“South Africa’s food system is very complex, nuanced and unequal and we need to spend quite a bit of effort getting to grips with its realities to figure out what a sustainable and healthy food system could look like.

“It’s certainly not a case of cut and paste from a global report to a national context. Some of these complex realities we need to keep in mind are: an unequal society, a dual agricultural system of large-scale commercial versus smallholder farmers, an ongoing nutrition transition to high-calorie processed and convenience foods, limited natural resources like water and fertile soils for growing food, as well as persistent poverty and hunger.”

She points to a recent report by World Wide Fund for Nature SA (WWF), “Agri-Food Systems: Facts and Futures”, which called for a fundamental overhaul of the country’s food system which, in its current form, is a threat to the environment and human health.

This report, says Reyers, refers to the “many absurdities, inadequacies and problematic practices in how our food is produced and what we consume.

“I think most of us are blissfully unaware of the rapid and large-scale changes taking place in our national food system - in how we produce, purchase and consume food. One central inadequacy (or absurdity) is that about 20% of South African households don’t have adequate access to food while on the other hand 33% of all food produced in South Africa, a total of 10million tons of edible food, is wasted every year.”

Addressing this level of food waste seems a good place to start. “Similarly, ensuring adequate access to sufficient nutritious food is a priority.”

SA is one of the most food secure countries on the continent in that it has enough food to feed everyone - in theory. “However, in practice almost a quarter of households go hungry, and another quarter are at risk of hunger. Ensuring sufficient and nutritious food to everyone is made challenging by the rapid nutrition transition going on in the country linked to substantial increases in processed and packaged food and meat and the ensuing obesity epidemic.

“So when it comes to the need for more healthy diets, South Africa aligns well with the findings of the global report - there is a need to increase healthy food consumption to achieve nutrition targets as well as to decrease unhealthy food consumption trends.”

Agriculture, including aquaculture, are major drivers of ecosystem and broader environmental changes in South Africa leading to the loss of species and ecosystems, air and water pollution from pesticides and fertilisers, as well as climate change from greenhouse gas emissions.

“These all have knock-on effects on our societies including impacts on health, poverty alleviation, and other development goals.

“Agriculture remains an important economic sector in South Africa, but there are examples of better and more responsible ways to grow food ... How we bring these into the mainstream will be key.

“A central tension in the report is around meat - as we know the production of meat is very land-use, greenhouse gas and environmentally intensive. And South Africans on average eat a lot of meat - more so than many other low and middle-income countries.

“But again the report is not suggesting everyone has to give up eating meat, rather that we figure out what balance of meat (including amount, type, source, production method) in our diets is appropriate for our ecosystems and our health, as well as being clear about ethical, environmental and equity consequences of these choices.”

As global and national populations grow, “we are going to have to face some hard choices about what a sustainable, healthy and fair food system looks like - and meat consumption is likely to be a key part of that discussion”, Reyers adds.

The WWF South Africa report, too, found SA will need to double food production by 2050, producing enough to feed as many as 73 million people. “There will be a doubling of demand for certain products - meat and dairy included - by 2050. How will we meet this? It can’t just be about more production. We need a complete transformation to a system so that it nurtures human health and the environment,” remarked the report’s author, Tatjana von Bormann, the programmes and innovation lead.

While the EAT-Lancet paper has drawn some criticism for being “vegetarian propaganda”, nutritionally insufficient and for its “top down” approach, among others, EAT-Lancet commission co-chair Professor Johan Rockstrom, says it’s been misinterpreted as as a uniform framework with a “one-size-fits-all” approach.

In February, Lancet Planetary Health wrote how debates around the planetary health diet are “reverberating in canteens and kitchens across the world.

“The purpose was not to tell people what they can and cannot eat and nor did they (the EAT-Lancet Commission) set out to propose the one diet that would save the world. Instead, they aimed to illustrate the ways that food production and consumption, perhaps more so than any other human activities, inextricably link the Earth’s natural systems and human health, and that this does not have to boil down to a choice between health or the environment.”

Food system in crisis

Tatjana von Bormann, the programmes and innovation lead at WWF South Africa, says EAT’s flagship event had a serious message - “the food system which underpins our society is in crisis and we risk certain climate and biodiversity catastrophe on the current course”.

This is a message WWF subscribes to. “We also agree with EAT’s message that it’s not only the situation that is at a point of urgency, but it’s also a place of tremendous opportunities - if managed right.”

Von Bormann is author of a report, “Agri-Food Systems: Facts and Futures”, released earlier this year and which calls for a fundamental overhaul of SA’s food system.

It describes how the way in which food is put on the country’s tables has done more damage to the natural environment than any other human enterprise, escalating biodiversity loss, deforestation, desertification and soil degradation, contributing to water scarcity and declining water quality, and causing widespread damage to marine ecosystems.

“We’re doing lots of work in diets and food waste - areas of critical engagement given the worsening state of health and nutrition...

“As is often the case, what is left out of a report can be as interesting as what is in it. (Commission co-chair)Professor Johan Rockström said the report did not set a time-frame because it is now, did not delve into malleability and complexity of stakeholder behaviour, didn’t explore livelihood of farmers and how necessary shift - like no rise in global meat production or consumption to 2050 - will impact them.

“Much of what I saw and heard confirmed that the work WWF South Africa has been involved in offers great value in adding to the suite of solutions required to bring about a food system that holds social justice at its core.”

Plant-based diets over meat

The current overconsumption of meat in Western diets is a significant contributor to poor health and increases a person’s risk of becoming overweight, obese or developing certain non-communicable diseases, says the EAT-Lancet Commission.

Projections show that a global adoption of a Western diet high in meat intake matched with global population and economic growth will drive significant health burdens and push food systems well beyond environmental limits - multiple studies make the same predictions.

Allocating increasingly scarce, high value agricultural lands or converting high carbon or high biodiversity ecosystems to agricultural land to produce foods is problematic - this guarantees the continued degradation of public health and failure to meet both the UN Sustainable Development Goals and the Paris Agreement.

This will also contribute to the growing social and economic costs of poor public health, climate disaster relief and environmental degradation.

Avoiding these risks calls for a significant reduction of unhealthy food consumption - particularly poorly produced meat - in high- income countries, in addition to avoiding increasing consumption trends in middle-income countries.

“At the same time, it is critical that the food system ensures sufficient access to healthy levels of protein that are sustainably produced where hunger and malnutrition persist,” the commission says.

Gerhard Schutte, of the Red Meat Producers’ Organisation, believes it’s “very one-sided” to single out the health problems of red meat.

“Red meats have a much better amino acid profile compared to plant proteins And if you look at South Africa, only 20% of our land is high quality arable land. Most of our natural resource is only suitable for livestock and game production.

“South African’s certainly don’t eat the most meat in the world, but we’re getting there. It will take a long time for most people to accept plant-based alternatives,” Schutte says.

Strategies to target

The Eat-Lancet Commission sets out five strategies to achieve its targets globally:

Encourage people to choose healthier diets by improving availability and access to healthy food.

Refocus agriculture from producing high volumes of crops to producing varied, nutrient-rich crops.